BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2589 (Gomez) - Public health: lactation services and
equipment
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|Version: June 27, 2016 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 2589 would require the system currently used to
assess eligibility for Medi-Cal and health care coverage through
Covered California to assess applicants for eligibility for the
WIC program and allow eligible individuals to complete an
electronic application for WIC benefits. The bill would also
require the Department of Public Health to develop measure and
outcomes for breastfeeding rates.
Fiscal
Impact:
One-time costs in the millions to low tens of millions, to
make required system changes to CalHEERS, the SAWs, and the
new WIC information technology system (General Fund and
potentially federal funds). In order to implement the bill's
requirement to allow applicant information to be shared by
either CalHEERS or a SAWs with an electronic WIC application,
significant information technology upgrades would be required
for all related systems. For CalHEERS and the SAWS, system
upgrades would be needed to allow systems to screen for
AB 2589 (Gomez) Page 1 of
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potential WIC eligibility, to get the applicant's consent to
share personal information with the WIC system, and to
securely share personal information with the new WIC system.
For the WIC program, the bill would require the new WIC
information technology system to allow for an electronic
application and to securely receive applicant information from
the other programs' eligibility systems. Whether those system
changes would be allowed by the federal government and whether
federal funding will be available to pay for those costs is
unknown. (See below).
One-time costs, likely in the hundreds of thousands per year
for one to two years for the Department of Public Health to
develop measure and outcomes for breastfeeding rates (General
Fund). The costs to implement this requirement of the bill
include staff costs to analyze existing information on current
breastfeeding rates and the health benefits of breastfeeding,
to support the required stakeholder process, and to develop a
report or other document that includes the results of the
process.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Under current state and federal law, Covered California
functions are the state's health benefit exchange. Individuals
can apply for subsidized health care coverage (and apply for
Medi-Cal coverage) through Covered California. The Covered
California application process can be performed online, over the
phone, or through enrollment counselors. The underlying
information technology system that is used to make eligibility
determinations for Covered California is known as the California
Health Care Eligibility, Enrollment, and Retention System
(CalHEERS). CalHEERS makes eligibility determinations for both
Covered California coverage and Medi-Cal coverage. Beginning in
late 2016, CalHEERS will be able to screen applicants for
eligibility for several other income based programs (CalFresh
AB 2589 (Gomez) Page 2 of
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and CalWorks) and will refer likely beneficiaries to those
programs. CalHEERS will not actually make eligibility
determinations or enroll eligible beneficiaries in those
programs.
The Women, Infants, and Children Program (WIC) is a federally
funded program that provides nutrition assistance to
low-to-moderate income families of pregnant and post-partum
women. Women who are enrolled in Medi-Cal are automatically
eligible for WIC.
Under current practice, eligibility determinations for the WIC
program are made by local WIC agencies (84 agencies with over
600 locations). The federal government requires that WIC
eligibility determinations be made as part of an in-person visit
that includes height and weight measurements of children and
nutritional assessments and counseling for the family.
Currently, WIC enrollees are issued paper checks with which they
can purchase eligible foods. The Department of Public Health,
which manages the WIC program, will soon begin the process of
updating the underlying WIC information technology system to
switch from paper checks to electronic benefit transfer cards.
The federal government must approve the information technology
system that the state selects. The federal government has
indicated that it will only approve systems that have been
implemented in other states. To date, it does not appear that
any other state has included an electronic application in their
new system and the Department does not anticipate including that
function in the new WIC IT system. Some states and local
agencies use online screening tools that allow potential
applicants to see whether they are likely to qualify for WIC and
to allow them to share their contact information with an
eligibility worker or schedule an appointment. It does not
appear that any of those systems actually perform eligibility
determinations.
Proposed Law:
AB 2589 would require the system currently used to assess
eligibility for Medi-Cal and health care coverage through
AB 2589 (Gomez) Page 3 of
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Covered California to assess applicants for eligibility for the
WIC program and allow eligible individuals to complete an
electronic application for WIC benefits. The bill would also
require the Department of Public Health to develop measure and
outcomes for breastfeeding rates.
Specific provisions of the bill would:
Require the Department of Public Health to coordinate with the
Department of Health Care Services and Covered California to
develop a system for information sharing to streamline the
enrollment into WIC as part of the process for applying for
Medi-Cal or Covered California health care coverage;
By January 1, 2019, require CalHEERS and the SAWS to identify
applicants potentially eligible for WIC, and if the applicant
consents and if there is an available WIC electronic
application, electronically link the applicant to that WIC
application;
By January 1, 2022, require CalHEERS and the SAWS to identify
applicants potentially eligible for WIC, and if the applicant
consents and if there is an available WIC electronic
application, allow an applicant to complete an electronic WIC
application without resubmitting data known to CalHEERS or the
SAWS;
Make implementation of the above requirements subject to
funding from the General Fund or federal funds if available;
Require the Department of Public Health, in consultation with
stakeholders, develop measures and outcomes for breast feeding
rates.
Staff
Comments: As noted above, the WIC program is fully funded by
the federal government and the federal government has to approve
changes to the underlying IT system. It is not clear whether the
federal government would approve the creation of an online
application for WIC, given that the federal government requires
in-person interactions with WIC agencies before an applicant is
enrolled in the program. If the federal government does not
approve the use of federal funding to pay for the costs to make
the necessary changes to WIC system, as well as the necessary
changes to CalHEERS and the SAWS, those costs would be a General
Fund cost. (If the federal government allowed the changes to be
made at all.)
It is also important to note that eligibility workers at WIC
agencies have access to the information technology system that
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tracks Medi-Cal participation. Therefore, when a women applies
for WIC, the eligibility worker is able to check whether the
applicant is enrolled in Medi-Cal. Because Medi-Cal enrollees
are considered to be automatically eligible for WIC, a
determination by the eligibility worker that a women is already
enrolled in Medi-Cal eliminates the need for the applicant to
demonstrate that she meets the income requirements of the
program.
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